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Anaesthesia Critical Care & Pain Medicine
Sous presse. Epreuves corrigées par l'auteur. Disponible en ligne depuis le lundi 21 janvier 2019
Doi : 10.1016/j.accpm.2018.12.009
Bleeding complications following peripheral regional anaesthesia in patients treated with anticoagulants or antiplatelet agents: A systematic review
 

F. Joubert a , P. Gillois b , H. Bouaziz c , E. Marret d , G. Iohom e , P. Albaladejo a,
a Department of anaesthesiology and intensive care, Grenoble Alpes university hospital, 38043 Grenoble, France 
b Department of public health, Grenoble Alpes university hospital, 38043 Grenoble, France 
c Department of anaesthesiology and intensive care, university of Lorraine, CHU Nancy, 54000 Nancy, France 
d Department of anaesthesiology and intensive care, AP–HP, university of Paris Sorbonne, 75005 Paris, France 
e Department of anaesthesia and intensive care medicine, Cork university hospital, Cork, Ireland 

Corresponding author.
Abstract
Background

Patients on either antiplatelet or anticoagulant therapy may need procedures performed under peripheral nerve blocks in preference to general anaesthesia techniques. The risk of bleeding associated with peripheral nerve blocks under these circumstances remains unknown. This systematic review evaluates the incidence of bleeding complications following peripheral nerve blocks in patients receiving antiplatelet and/or anticoagulant medication.

Method

All English, French and Spanish publications on peripheral nerve blocks in patients receiving antiplatelet and/or anticoagulant medication, from 1978 to 2018 from various sources including Pubmed, were reviewed. Publications on neuraxial anaesthesia (spinal or epidural) and eye blocks were excluded.

Results

Twenty-four articles were selected, including six observational studies and 18 case reports. Patients received antiplatelet agents only, in 4 studies, anticoagulants only in 14 studies, and both in 6 studies. In the observational studies, 80 bleeding complications (haematoma or minor bleeding at the puncture site) were identified following 9738 peripheral nerve blocks. Amongst case reports, 15 bleeding complications were noted following 50 peripheral nerve blocks. Bleeding complications were reported mostly with lumbar plexus blocks (1 requirement for blood transfusion, 1 catheter embolization, 1 surgical exploration and 1 death). The overall estimate of the incidence of bleeding complications was 0.82% (0.64%–1.0%).

Conclusion

This systematic review found that bleeding complications following peripheral nerve blocks were rare in patients receiving antiplatelet and/or anticoagulant medication.

The full text of this article is available in PDF format.

Keywords : Nerve block, Anticoagulant, Antiplatelet agent, Platelet aggregation inhibitors, Haemorrhagic complications




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